CMS Manual System

1 CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3695 Date: January 20, 2017 Change Request 9935 SUBJECT: Medicare Outpatient Observation Notice (MOON) instructions I. SUMMARY OF CHANGES: The purpose of this change request (CR) is to update Chapter 30 of Pub. 100-04 to include the Medicare Outpatient Observation Notice (MOON), CMS-10611, form instructions . The MOON was developed to inform all Medicare beneficiaries when they are an outpatient receiving observation services, and are not an inpatient of the hospital or critical access hospitals (CAH). The form instructions to be included in Chapter 30 provide guidance for proper issuance of the MOON. EFFECTIVE DATE: February 21, 2017 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: February 21, 2017 Disclaimer for Manual changes only: The revision date and transmittal number apply only to red italicized material.

2 Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN Manual instructions : (N/A if Manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE R 30/Table of Contents N 30/ 400/ Part A Medicare Outpatient Observation Notice III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

3 IV. ATTACHMENTS: Business Requirements Manual Instruction Attachment - Business Requirements Pub. 100-04 Transmittal: 3695 Date: January 20, 2017 Change Request: 9935 SUBJECT: Medicare Outpatient Observation Notice (MOON) instructions EFFECTIVE DATE: February 21, 2017 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: February 21, 2017 I. GENERAL information A. Background: This CR updates Chapter 30 of Pub. 100-04 to include the MOON, CMS-10611, form instructions . The MOON was developed to inform all Medicare beneficiaries when they are an outpatient receiving observation services, and are not an inpatient of the hospital or CAH. The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015. B. Policy: The NOTICE Act (Pub. L. 114-42). II. BUSINESS REQUIREMENTS TABLE "Shall" denotes a mandatory requirement, and "should" denotes an optional requirement.

4 Number Requirement Responsibility A/B MAC DME MAC Shared- System Maintainers Other A B HHH FISS MCS VMS CWF Hospitals shall observe the inclusion in Chapter 30 of the MOON and its instructions in Chapter 30 of Pub. 100-04. X X Hospital, Providers Contractors shall be aware that this CR and its content are informational only for contractors. There are no actions contractors must take to distribute or process the MOON when it is submitted as part of the patient medical record. X X Providers III. PROVIDER EDUCATION TABLE Number Requirement Responsibility A/B MAC DME MAC CEDI A B HHH MLN Article: A provider education article related to this instruction will be available at shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within 5 business days after receipt of the notification from CMS announcing the availability of the article.

5 In addition, the provider education article shall be included in the contractor's next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly. X X IV. SUPPORTING information Section A: Recommendations and supporting information associated with listed requirements: "Should" denotes a recommendation. X-Ref Requirement Number Recommendations or other supporting information : Section B: All other recommendations and supporting information : N/A V. CONTACTS Pre-Implementation Contact(s): Janet Miller, 404-562-1799 or Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR). VI. FUNDING Section A: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract.

6 CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. ATTACHMENTS: 0 Medicare Claims Processing Manual Chapter 30 - Financial Liability Protections Table of Contents ( , Issued: 01-20-17, Effective: 02-21-17, Implementation: 02-21-17) Transmittals for Chapter 30 400 - Part A Medicare Outpatient Observation Notice Statutory Authority Scope Medicare Outpatient Observation Notice Intersection with State Observation Notices 400 - Part A Medicare Outpatient Observation Notice ( , Issued: 01-20-17, Effective: 02-21-17, Implementation: 02-21-17) The MOON informs all Medicare beneficiaries when they are an outpatient receiving observation services, and are not an inpatient of the hospital or critical access hospital (CAH).

7 Statutory Authority ( , Issued: 01-20-17, Effective: 02-21-17, Implementation: 02-21-17) On August 6, 2015, Congress enacted the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) Public Law 114-42, amending Section 1866(a)(1) of the Social Security Act (the Act) (42 1395cc(a)(1)), by adding a new subparagraph (Y). The NOTICE Act requires hospitals and CAHs to provide written and oral explanation of such written notification to individuals who receive observation services as outpatients for more than 24 hours. The process for delivery of this notice, the Medicare Outpatient Observation Notice (MOON), was addressed in rulemaking, including a final rule, CMS-1655-F (81 FR 56761, 57037 through 57052, August 22, 2016), effective October 1, 2016. The resulting regulations are located at 42 CFR Part (y). Scope ( , Issued: 01-20-17, Effective: 02-21-17, Implementation: 02-21-17) The MOON must be delivered to beneficiaries in Original Medicare (fee-for-service) and Medicare Advantage enrollees who receive observation services as outpatients for more than 24 hours.

8 The hospital or CAH must provide the MOON no later than 36 hours after observation services as an outpatient begin. This also includes beneficiaries in the following circumstances: Beneficiaries who do not have Part B coverage (as noted on the MOON, observation stays are covered under Medicare Part B). Beneficiaries who are subsequently admitted as an inpatient prior to the required delivery of the MOON. Beneficiaries for whom Medicare is either the primary or secondary payer. NOTES: For purposes of these instructions , the term beneficiary means either beneficiary or representative, when a representative is acting for a beneficiary. Please see Chapter 13 of the Medicare Managed Care Manual for Medicare Advantage instructions . The statute expressly provides that the MOON be delivered to beneficiaries who receive observation services as an outpatient for more than 24 hours. In other words, the statute does not require hospitals to deliver the MOON to all beneficiaries receiving outpatient services.

9 The MOON is intended to inform beneficiaries who receive observation services for more than 24 hours that they are outpatients receiving observation services and not inpatients, and the reasons for such status, and must be delivered no later than 36 hours after observation services begin. However, hospitals and CAHs may deliver the MOON to an individual receiving observation services as an outpatient before such individual has received more than 24 hours of observation services. Allowing delivery of the MOON before an individual has received 24 hours of observation services affords hospitals and CAHs the flexibility to deliver the MOON consistent with any applicable State law that requires notice to outpatients receiving observation services within 24 hours after observation services begin. The flexibility to deliver the MOON any time up to, but no later than, 36 hours after observation services begin also allows hospitals and CAHs to spread out the delivery of the notice and other hospital paperwork in an effort to avoid overwhelming and confusing beneficiaries.

10 Hospitals Affected by these instructions . These instructions apply to hospitals as well as CAHs per section 1861(e) and section 1861(mm) of the Social Security Act. Medicare Outpatient Observation Notice ( , Issued: 01-20-17, Effective: 02-21-17, Implementation: 02-21-17) The MOON is subject to the Paperwork Reduction Act (PRA) process and approval by the Office of Management and Budget (OMB). The MOON may only be modified as per their accompanying instructions , as well as per guidance in this section. Unapproved modifications cannot be made to the OMB-approved, standardized MOON. The notice and accompanying instructions may be found online at Alterations to the MOON ( , Issued: 01-20-17, Effective: 02-21-17, Implementation: 02-21-17) In general, the MOON must remain two pages, unless inclusion of additional information per section or State-specific information per section below results in additional page(s). Hospitals and CAHs subject to State law observation notice requirements may attach an additional page to the MOON to supplement the Additional information section in order to communicate additional content required under State law, or may attach the notice required under State law to the MOON.